Provider Demographics
NPI:1376049163
Name:WILCOXSON, ASHLEY CAROL
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CAROL
Last Name:WILCOXSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CASEY ST STE A
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-6858
Mailing Address - Country:US
Mailing Address - Phone:270-465-7768
Mailing Address - Fax:
Practice Address - Street 1:121 CASEY ST STE A
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-6858
Practice Address - Country:US
Practice Address - Phone:270-465-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175296224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY175296OtherCERTIFIED OCCUPATIONAL THERAPIST ASSISTANT
KY$$$$$$$$$Medicaid